House of Lords

Monday, 18th March 1996.

The House met at half-past two of the clock: The CHAIRMAN OF COMMITTEES on the Woolsack.

Prayers--Read by the Lord Bishop of Sheffield.

NHS Changes: Public Representations

Lord Molloy asked Her Majesty's Government:

Whether a majority of any public representations they have received concerning recent changes to the National Health Service has supported those changes.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege): My Lords, we receive representations for and against all our policies. We are satisfied that the changes we have introduced into the NHS are improving performance.

Lord Molloy: My Lords, I am truly grateful to the Minister for that reply. However, there are views different from what she has said from responsible people such as the Institute of National Affairs, which says that there has been a decline of 10 per cent. in the way that people think of the NHS. They believe it is not as good as it was. British Social Attitudes claims that the NHS, which is reasonably well run, is slowly declining and that action should be taken to redress that. The Minister should address that problem, because it seems that a wonderful service could now be on a nasty decline.

Baroness Cumberlege: My Lords, we are improving the health of the nation. Coronary heart disease has fallen by nearly 11 per cent.; strokes by over 5 per cent.; some cancers by over 3 per cent.; and we have nearly eliminated measles, the first country in Europe to do so. For every 100 patients treated before the reforms, we now treat 125. A recent survey of GP fundholders shows real dividends in primary care. The Patient's Charter has halved the average waiting time for elective treatment. Your Lordships, through your report Medical Research and the NHS Reforms, have warmly endorsed the NHS R&D strategy. That is a very, very good record.

Baroness Oppenheim-Barnes: My Lords, is my noble friend aware that I have no idea to whom the institute quoted might have spoken to come by that piece of information, because the general view of people, especially those not in large city conurbations, is that the service has improved greatly; that the scope and availability of treatment have greatly improved; and that when there are occasional, widely publicised things which are unacceptable, they form a small minority, not the majority, of what is happening in the health service.

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Baroness Cumberlege: My Lords, I totally endorse my noble friend's view. A recent survey from the National Association of Health Authorities shows that the satisfaction rate is about 86 per cent. of the general population.

Lord Stoddart of Swindon: My Lords, can the Minister tell us about NHS dentistry? Are there more or fewer dentists in the NHS as a result of the recently negotiated contract? Are NHS dentists treating more people these days than they were a few years ago? Have the numbers in the NHS decreased or increased?

Baroness Cumberlege: My Lords, we have more dentists in the NHS at the moment. The noble Lord will be aware that they can treat private patients as well as NHS patients. That has been the situation for decades. We now have more registered patients in the NHS than we had five years ago.

Lord Geddes: My Lords, I declare an interest as a non-executive director of an NHS hospital trust. Is my noble friend aware that the reaction that this hospital receives from the vast majority of the public is greatly in favour of the changes in the NHS and the standard of care that is being given?

Baroness Cumberlege: My Lords, yes; and I believe that that is true of many hospitals up and down the land.

Baroness Jay of Paddington: My Lords, does the Minister agree with the reported remarks of the chief executive of the NHS, Mr. Alan Langlands, who said a month ago:

"The efficiency drive may have gone 'a bit far'.... We may need to think about qualitative aspects of care and be less concerned about always increasing throughput"?

Is not the chief executive echoing the concerns expressed by my noble friend and many NHS workers and patients that what we need in the NHS is a return to public service values?

Baroness Cumberlege: My Lords, the noble Baroness will be aware of the Clinical Standards Advisory Group which ensures that clinical standards are maintained. The evidence-based practice and clinical audit ensures that clinical standards are not just maintained but are improved. There is an issue about efficiency. We have to be careful not to press the NHS too hard. However, patients are grateful that the average waiting time has been so reduced and that we are treating more patients than ever before.

Baroness Farrington of Ribbleton: My Lords, does the Minister accept that the reply she gave a few moments ago about the state of the dental service available to people under the NHS is not that experienced by a large and growing number of people? Will she give an assurance that an NHS dental service will be available to every member of the public within a reasonable distance of their homes? Does she agree that that availability has deteriorated over the past 15 years?

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Baroness Cumberlege: My Lords, if any patient finds difficulty in gaining access to an NHS dentist he or she should approach the Family Health Services Authorities, which will ensure access.

Free Prescription Drugs for Men

2.43 p.m.

Lord Boyd-Carpenter asked Her Majesty's Government:

Why they did not seek parliamentary approval of their decision to apply the decision of the European Court of Justice that the age of eligibility for free prescription drugs for men should be lowered to 60.

Baroness Cumberlege: My Lords, the Government's decision to lower the age of eligibility to 60 was implemented by means of a negative instrument which was laid before both Houses on 19th October last year.

Lord Boyd-Carpenter: My Lords, I thank my noble friend for that Answer. Should not a change which involves an additional expenditure of £40 million a year, as has now been admitted, have had positive parliamentary approval by way of legislation?

Baroness Cumberlege: My Lords, a Statement was made by my honourable friend the Minister for Health in another place when the decision was taken. The Statement was offered to this House through the usual channels but the decision was made not to repeat it. Furthermore, when the instrument was laid any Member of your Lordships' House could have tabled a Prayer amending the regulations within the 40 sitting days allowed.

Lord Renton: My Lords, is my noble friend aware that in recent years the European Court of Justice has taken upon itself to add to legislative provisions of the European Community instead of confining itself to interpreting them? Can a protest be made at the forthcoming Intergovernmental Conference in order to stop that practice?

Baroness Cumberlege: My Lords, it was a decision of the European Court of Justice. In this case, the court decided that the principle of equality between men and women in matters of social security should apply in the area of prescription charges. However, it was left to the United Kingdom to decide how to implement the principle. Although the European Court decided the principle, it was left to the United Kingdom to decide how to implement it. Indeed, we could have implemented the decision with savings; rather than equalising at 60 we could have equalised at 63 or 65.

Lord Stoddart of Swindon: My Lords, does the Minister agree that when the directive was discussed in the House of Commons and in your Lordships' House there was no mention of the fact that it would extend beyond equality in pensions? There was no discussion about it and Parliament was not involved. The noble Lord, Lord Boyd-Carpenter, is correct in saying that the

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European Court has now imposed upon Parliament, without its consent, £40 million-worth of expenditure which it did not expect.

Baroness Cumberlege: My Lords, I understand that the Labour Government of the day agreed to the directive when it was published in 1978. I had presumed that it covered social security matters. The European Court has decided that prescription charges should be aligned to social security whereas this Government had presumed the interpretation to be that it should be aligned to health matters.

Lord Boyd-Carpenter: My Lords, why, apart from failure to legislate, was there a failure to repeat in this House the Statement made in another place? Was it because the Opposition did not want it?

Baroness Cumberlege: My Lords, yes, that was the case.

Professor Muhammed al-Mas'ari

2.46 p.m.

Lord Avebury asked Her Majesty's Government:

How they will respond to the decision of the adjudicator in the case of Professor Muhammed al-Mas'ari announced on 5th March.

The Minister of State, Home Office (Baroness Blatch): My Lords, my right honourable friend the Home Secretary is considering the case further.